I am a 29-year-old male who has recently started exercising. I have generalized anxiety disorder and I am in nursing school, I do not take any medication for my anxiety as I am pretty good at managing it with mental exercises, etc. I recently had many heart tests done. These heart tests included an Abdominal Aortic Aneurysm test, a stroke/carotid artery test, an ankle-brachial index test, and an Echocardiogram, all of which returned NO abnormal results. My blood pressure hovers around 140/80. My HDL was a little low at 32 mg/dL. My heart rate is generally 80-90 BPM. I weigh 150 pounds. I don't smoke. I limit my salt intake. I don't drink ANY caffeine.

Now on to my issue. I have had VERY frequent PVCs (I know they are PVCs because they were captured via EKG and diagnosed by two doctors), by frequent I mean they probably average 1 every 10 minutes, and they sometimes come in bursts of two. I went to my PCP and the ER (just as a precaution because I read they are generally benign), and they said it was nothing at all to worry about and that they think my stress from nursing school and anxiety might be causing them. They said I should have no problems exercising. Well, today I ran for about 5 minutes (to just ease into cardio work), and my HR got up to about 150. In about 25 minutes after exercising, my HR was about 110. After a little bit of rest, I did 20 pushups and checked my HR immediately after, and it was 140 BPM again. This is a concern for me because I am not that out of shape and it just seems like my heart rate is too high. I didn't have any angina or shortness of breath or anything, but I was just wondering if, given all of these things I just told you, you think I might have some underlying heart issue? Is it normal for my HR to spike that quickly after just 20 pushups? Do you think I should be seen for further evaluation because of the continued PVCs and seemingly high heart rates after moderate exercise?

Symptomatic premature ventricular contractions (PVC’s) are very common, even among young, relatively healthy patients. PVC’s in the absence of structural heart disease (normal echocardiogram) carries a benign prognosis, but they can still be problematic to patients. It sounds as if you are following good lifestyle changes. I would also add to ensure that you avoid sleep deprivation.

Now, to address the exercise symptoms. Since you are beginning a new exercise program, it is no surprise you have poor heart rate recovery and your heart rate rises rapidly. These are common findings in deconditioning. In patients with similar symptoms, these often improve with more exercise. If a patient reported similar symptoms, I would not pursue further evaluation in the absence of chest pain or syncope (passing out) or presyncope (almost passing out) or shortness of breath. However, if the symptoms persist, the definitive test would be an exercise treadmill stress test (performed by cardiologists). An even more definitive test would be a cardiopulmonary exercise test (often times performed by pulmonary physicians or cardiologists), which could further delineate the cause of your limitation (respiratory vs. cardiac vs. deconditioning). However, patients that have a quick time to max heart rate and poor heart rate recovery but are otherwise asymptomatic are often deconditioned - symptoms improve with a structured exercise program.

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